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“I think with regards to the definition of paper free, I would say we’ve now achieved it against the original timetable, which was 2018,” David Walliker, CIO at Royal Liverpool and Broadgreen University Hospitals NHS Trust and Liverpool Women’s NHS FT, told BJ-HC

At the beginning of April, BJ-HC visited Royal Liverpool and Broadgreen University Hospitals NHS Trust to find out the latest developments in their digital infrastructure

[Liverpool, UK] With in-house systems rated ‘outstanding’ by the CQC, involvement in the Global Digital Exemplars (GDE) scheme, a new building and an integrated EPR, Royal Liverpool and Broadgreen University Hospitals NHS Trust (RLBUHT) continues to stand out amongst its peers.

The trust is situated in Liverpool’s Knowledge Quarter, which encompasses more than £1bn worth of investment, bringing together ‘key players’, aiming to close the ‘economic gap with London’.

“It’s quite an exciting time for this part of Liverpool and it’s all underpinned by, obviously, digital technology,” David Walliker, CIO of RLBUHT and Liverpool Women’s NHS FT, told BJ-HC.

However, it is widely known Liverpool has higher variations in ‘poor health’, with people residing in wealthier areas living 12 years longer than people that live in poorer areas, prompting the development of Healthy Liverpool, a programme led by the NHS Liverpool CCG, set to maximise efficiency of healthcare provision in five different categories: living well, digital care and innovation, community services, urgent and emergency care and hospital services.

Healthy Liverpool’s Digital Lead, Kate Warriner, told BJ-HC that ‘digital’ sits across all the work that they’re carrying out, although adding health IT is a ‘really exciting area in its own right’; the scheme is currently focusing on assistive technologies and joining up shared care records.

Four key digital workstreams

Warriner is also the trust’s lead for the GDE scheme, set to underpin the other three primary pieces of work included within their digital strategy, as mentioned in their latest board papers.

The digital innovation workstream, in line with the Healthy Liverpool programme, includes sensor and assistive technologies, while the internal workstream focuses on clinical transformation, involving different mathematicians, professors and clinicians and ‘letting them come up’ with different ways of healthcare delivery: “Everything we do has to be clinically led, otherwise, why bother?” Walliker explained.

These workstreams will underpin the work done to establish the new Royal, a new build costing approximately £435m that will be opened next year. Walliker added it will be different in many ways in comparison to the current one, not only in ‘look’:

“It’s single rooms, 649 individual rooms, which is great from a privacy perspective, it’s great from an infection perspective. So, if a patient gets an infection, then we only have to close the one room instead of closing the entire bay.”

However, the build also opens up a different raft of challenges: “So the hospital’s completely online, it will be a hospital of things, which does in itself present cybersecurity challenges alongside, but also significant opportunities,” Walliker went on to add.

Mike Fisher, CCIO and Consultant Cardiologist at the trust, explained a decision was taken when the new hospital was designed to not put a medical records department in the building.

“Once it opens if we’re not paperless then we don’t have a hospital because there’s no way of moving a piece of paper after a patient in that building, there’s no infrastructure for doing that, so that was our primary motivation behind the big push towards the digital project,” he clarified.

New ‘genuinely integrated’ EPR

The trust has therefore agreed to deploy InterSystems’ EPR, along with two other local organisations: Aintree University Hospitals NHS FT and Liverpool Women’s NHS FT: “That’s about 75% of adult activity in the city, so that will be on one contemporaneous record,” added Walliker.

The other two trusts have now both entered the contract, but due to the ‘wonders of NHS governance’, as Walliker says, although the business case has been approved at all three trust boards, the Royal can’t enter it until they get NHS Improvement approval.

Fisher explained the paperless drive came with the new hospital as they decided the best strategy would be to procure and deploy an integrated EPR system in order to have ‘proper decision support’, adopting initially a two-stage strategy to safely transfer to the new build.

“I have to say there were times when I thought it wasn’t going to be possible, but we’ve done it,” he added, explaining the process had a lot of ‘clinical involvement’, with several demonstrations and visits to other sites.

He revealed some of the reasons why the trust chose InterSystems were due to their EPR being a ‘genuinely integrated’ product: “Quite a lot of the other allegedly integrated EPRs are actually nothing of the sort, they’ve been procured as different modules in some cases from different companies and they’ve been put together with a common interface over them.”

Interoperability, however, was another point of focus: “Although it’s not something that tends to figure largely in most clinician minds and indeed most CIO minds actually when they’re thinking about EPRs, interoperability for me is key because the thing is that it doesn’t matter how integrated your system is, you’re always going to have to interoperate with other things.”

Keep an eye out for the second part of our site visit article, out next week, to find out about the trust’s other digital workstreams and the GDE programme.

David Walliker will also detail their latest developments at UK e-Health Week, taking place at Olympia in London on the 3rd and 4th of May, showcasing a GDE zone.